S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8229
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             November 6, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend the public health law and the social services law, in
   relation to rates of payment for services under medical assistance  to
   needy persons
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 2807 of the public health law is amended by  adding
 a new subdivision 22 to read follows:
   22.  NOTWITHSTANDING  ANY  CONTRARY  PROVISION  OF THIS SECTION OR ANY
 OTHER LAW  OR  REGULATION,  THE  COMMISSIONER  SHALL  ESTABLISH  MEDICAL
 ASSISTANCE  RATES  OF  PAYMENT  FOR HOSPITAL SERVICES AND HEALTH-RELATED
 SERVICES  THAT  ARE  REASONABLY  RELATED  TO  THE  COSTS  OF   EFFICIENT
 PRODUCTION  OF  SUCH  SERVICES  AND WHICH ARE REASONABLE AND ADEQUATE TO
 MEET THE COSTS WHICH MUST BE INCURRED BY  EFFICIENTLY  AND  ECONOMICALLY
 OPERATED  FACILITIES  AND SERVICE PROVIDERS. SUCH RATES OF PAYMENT SHALL
 NOT BE BASED ON INFORMATION OR A BASE YEAR  CALCULATION  WHICH  IS  MORE
 THAN FOUR CALENDAR YEARS OLD.
   §  2.  Section  2807-c of the public health law is amended by adding a
 new subdivision 34-a to read as follows:
   34-A. THE COMMISSIONER SHALL ESTABLISH DISCRETE RATES OF  PAYMENT  FOR
 GENERAL  HOSPITALS  FOR  PAYMENTS  UNDER  THE MEDICAL ASSISTANCE PROGRAM
 PURSUANT TO TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW  FOR
 PERSONS ELIGIBLE FOR MEDICAL ASSISTANCE WHO ARE ENROLLED IN HEALTH MAIN-
 TENANCE  ORGANIZATIONS  AND  FOR  PAYMENTS  UNDER THE FAMILY HEALTH PLUS
 PROGRAM FOR PERSONS ENROLLED IN APPROVED ORGANIZATIONS PURSUANT TO TITLE
 ELEVEN-D OF ARTICLE FIVE OF THE SOCIAL SERVICES LAW AND THE CHILD HEALTH
 INSURANCE PLAN UNDER SECTION TWENTY-FIVE HUNDRED ELEVEN OF THIS  CHAPTER
 WHICH  ARE  REASONABLY  RELATED  TO THE COSTS OF EFFICIENT PRODUCTION OF
 SUCH SERVICES AND WHICH SHALL BE REASONABLE AND  ADEQUATE  TO  MEET  THE
 COSTS  WHICH  MUST  BE INCURRED BY EFFICIENTLY AND ECONOMICALLY OPERATED
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13466-01-3
              

 A. 8229                             2
 
 FACILITIES AND SERVICE PROVIDERS. SUCH RATES OF  PAYMENT  SHALL  NOT  BE
 BASED  ON INFORMATION OR A BASE YEAR CALCULATION WHICH IS MORE THAN FOUR
 CALENDAR YEARS OLD.
   §  3.  Paragraph  (a) of subdivision 18 of section 364-j of the social
 services law, as amended by chapter 649 of the laws of 1996, is  amended
 to read as follows:
   (a) The department of health may, where not inconsistent with the rate
 setting authority of other state agencies and subject to approval of the
 director  of the division of the budget, develop reimbursement methodol-
 ogies and fee schedules for determining the amount of payment to be made
 to  managed  care  providers  under  the  managed  care  program.   Such
 reimbursement methodologies and fee schedules may include provisions for
 payment   of   managed  care  fees  and  capitation  arrangements.  SUCH
 REIMBURSEMENT METHODOLOGIES  AND  FEE  SCHEDULES  OF  PAYMENT  SHALL  BE
 REASONABLY RELATED TO THE COSTS OF EFFICIENT PRODUCTION OF SUCH SERVICES
 AND  SHALL  BE  REASONABLE  AND ADEQUATE TO MEET THE COSTS WHICH MUST BE
 INCURRED BY EFFICIENTLY AND ECONOMICALLY OPERATED FACILITIES AND SERVICE
 PROVIDERS. RATES OF PAYMENT SHALL NOT BE BASED ON INFORMATION OR A  BASE
 YEAR CALCULATION WHICH IS MORE THAN FOUR CALENDAR YEARS OLD.
   §  4. The social services law is amended by adding a new section 363-g
 to read as follows:
   § 363-G. DISCLOSURE OF MEDICAID REIMBURSEMENT METHODOLOGY. THE COMMIS-
 SIONER OF HEALTH SHALL ANNUALLY DEVELOP AND  POST  ON  THE  DEPARTMENT'S
 WEBSITE   A  LIST  OF  ALL  MEDICAID  PROVIDER  TYPES  WITH  A  DETAILED
 DESCRIPTION OF THE MEDICAID REIMBURSEMENT METHODOLOGY APPLICABLE TO EACH
 PROVIDER TYPE. SUCH DESCRIPTION SHALL INCLUDE INFORMATION ON BOTH  OPER-
 ATING  AND  CAPITAL  REIMBURSEMENT METHODOLOGIES. THE COMMISSIONER SHALL
 ALSO DEVELOP AND PUBLISH ON THE DEPARTMENT'S WEBSITE A  DETAILED  YEARLY
 WORKPLAN  FOR  REIMBURSEMENT  MODERNIZATION  ACROSS  MEDICAID  AND OTHER
 PUBLIC INSURANCE PROGRAMS.
   § 5. This act shall take effect on the thirtieth day  after  it  shall
 have  become  a  law;  provided, however, that the amendments to section
 364-j of the social services law made by section three of this act shall
 not affect the repeal of such section and shall be deemed repealed ther-
 ewith.